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Biomedical subjects

F Harris

Publications and source records attributed to F Harris.

At least 19 recordsLinked to original sources

Intoxication and injury.

The relationship between alcohol use and injury severity was investigated in trauma patients admitted to a tertiary referral hospital during a 23-month period. Admission blood alcohol levels (BALs) were obtained on 427 trauma patients, who were stratified into three groups: those with no measurable blood alcohol, those within the legal limit of 100 mg/dL, and those over the legal limit or intoxicated. The no-alcohol group had significantly lower injury severity than the other two groups (p less than 0.001). Even when the BAL was well within the legal limit, injuries suffered by those in the alcohol-positive groups were more severe than those in the no-alcohol group. Confirmatory evidence of the effect of alcohol on injury severity was reflected by a 2.3% mortality in alcohol-negative patients compared with a 13.3% death rate in alcohol-positive patients (p less than 0.0001). To assess the potentially confounding effect of alcohol on injury scoring accuracy, we examined the change in Glasgow Coma Scale (GCS) scores following admission. No significant differences were found when admission GCS values were compared with GCS determinations made 24 hours following admission by separate observers. To correct for any potential bias as a tertiary referral center, repeat analysis with exclusion of transferred patients was done with essentially no change in results. Our data revealed a highly significant relationship between alcohol use, degree of injury, and resource consumption.

Adult

An updated study of taconite miners and millers exposed to silica and non-asbestiform amphiboles.

This is the second update of a study of 3,444 taconite miners and millers who were first exposed to taconite, with associated exposures to silica and nonasbestiform amphiboles, in the period 1947 through 1958. Previous analyses of deaths through 1977, and again through 1983, showed no significant excess deaths from any specific causes. The present study continues the follow-up through 1988, adding 14,748 person-years of observation and 261 death certificates for analysis. The population, reduced to 3,431 because of the detection of 13 earlier duplications, has now been observed for 101,055 person-years, with 1,058 deaths and 1,039 death certificates. Death certificates were obtained for 98.2% of those known to be dead. The total number of deaths was significantly fewer than expected. Based on US rates, the standardized mortality ratio (SMR) was 83 (ie, 83% of expected). Based on Minnesota death rates, it was 91. With both US and Minnesota death rates, the SMRs for malignant neoplasms, cancer of the respiratory tract, cancer of the digestive system, heart disease, nonmalignant respiratory disease, and cirrhosis of the liver were all below 100. Slightly elevated SMRs were found for cancer of the colon, cancer of the kidney, and lymphopoietic cancer. These elevations were not statistically significant. Separate analyses were made of total deaths, lung cancer deaths, and kidney cancer deaths in men who had worked with taconite for time periods of less than 1 year, 1-5 years, 5-10 years, and over 10 years, during observation periods less than 10 years, 10-20 years, and over 20 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Dust

The epidemiologic features of nosocomial infections in patients with trauma.

Sepsis is a major cause of morbidity and mortality in patients with trauma. To elucidate factors that might lead to infection, we studied the epidemiologic characteristics of nosocomial infections in our patient population with trauma. During a 3.5-year period, 2496 patients were entered into our hospital trauma registry and cross-matched with hospital infection control surveillance information. Two hundred twenty-nine patients with trauma and nosocomial infections were identified (9.2%), a figure that was nearly twice the nosocomial infection rate for the general hospital population. The majority of those infected were either orthopedic (51%), general surgical (25%), or neurosurgical (13%) patients. The most common sites of first infection were urinary tract (61%) or respiratory system (14%). Patients developing nosocomial infections were significantly older and had a higher Injury Severity Score than those who did not. Injury site was related to risk of infection with injuries of the spine, chest, and extremity showing the most significant relationship. The length of stay as well as hospital charges were significantly related to the occurrence of infectious complications. By determining the patient with trauma at risk for infection, treatment strategies can be designed to minimize septic complications.

Accidents

Evaluation of the rapid CLEARVIEW Chlamydia test for direct detection of chlamydiae from cervical specimens.

The CLEARVIEW Chlamydia test (Unipath, Mountain View, Calif.), a 30-min immunoassay, was compared to a standard tissue culture technique for the direct detection of chlamydiae from 677 cervical specimens obtained from 667 patients. For data analysis, 15 specimens were eliminated because of toxicity in the culture and 14 were eliminated because of failure of the extracted specimen to migrate in the CLEARVIEW test, one of the latter group being culture positive. Of the remaining 648 specimens, 40 were culture positive, of which 38 were detected by the CLEARVIEW test, and 12 specimens were positive only by the CLEARVIEW test. Therefore, the CLEARVIEW in comparison with culture was easier to perform, more rapid, and in this low prevalence (6.2%) population had a 95.0% sensitivity, 98.0% specificity, and 76.0% positive and 99.7% negative predictive values.

Adolescent

Features and outcome in meningococcal disease presenting with maculopapular rash.

Sixty nine patients with meningococcal disease some of whom presented with a maculopapular rash were entered in a prospective multicentre study. The clinical and laboratory features of children presenting with maculopapular rashes were compared with those of children presenting with typical haemorrhagic rashes. Of the 69 children 26 (38%) developed maculopapular rashes; nine (13%) had a maculopapular rash only, and the remaining 17 had a mixed maculopapular-purpuric rash. Twelve of the 17 (7%) had less than 12 petechiae. Children with maculopapular rashes had significantly higher platelet counts (median 294 compared with 243 x 10(9)/l), and plasma total haemolytic complement activity (80.5 compared with 65.0 U/ml) and significantly lower Glasgow meningococcal septicaemia prognostic scores (2.5 compared with 5.5) than those with purpuric rashes on admission. There were no significant differences between the groups in mortality, white cell count or absolute neutrophil count on admission, or C reactive protein concentration. Meningococcal disease can present with a maculopapular rash alone but this does not necessarily mean that the disease is less severe.

Complement Hemolytic Activity Assay

Ascertainment of congenital malformations: a comparative study of two systems.

STUDY OBJECTIVE: The aim was to compare the Office of Population Censuses and Surveys (OPCS) notification system for congenital malformation surveillance and the Liverpool Congenital Malformations Registry (LCMR) with respect to efficiency and uniformity of ascertainment, diagnostic accuracy, and overreporting of minor malformations. DESIGN: Manual matching of computer listings was done, using date of birth, sex, birthweight, and health district of residence. Maternal age was used to confirm the match. SETTING: Data were collected in the English health districts of Liverpool, St Helens and Knowsley, Southport and Formby, South Sefton, and Wirral over the years 1980-1985. SUBJECTS: 1959 malformed children notified to OPCS and 2649 notified to LCMR were assessed. MAIN RESULTS: 35.5% of malformed children ascertained by LCMR within seven days of birth were not notified to OPCS; 35.7% of cases reported to OPCS were exclusions from the LCMR protocol as being trivial malformations according to EUROCAT (European Registry of Congenital Anomalies) guidelines. Misclassification was infrequent but in 11.2% of cases the additional malformations present were not notified to OPCS. Conditions readily diagnosed at birth, such as neural tube defects, exomphalos, and facial clefts, were well ascertained by OPCS but others such as oesophageal atresia and Down's syndrome were not. CONCLUSIONS: It is important that national surveillance of congenital malformations should continue. However, several modifications to the present OPCS monitoring system are necessary, including greater standardisation of data collection, the exclusion of trivial and clinically non-significant malformations, and the inclusion of data on therapeutic abortions performed for fetal abnormality. These issues are being addressed by OPCS.

Congenital Abnormalities

A proposal for the measurement of the level of fluctuating background noise used in audiology.

Disturbances of communication in noisy environments may be identified sooner in patients with sensorineural hearing loss when speech audiometry is performed using fluctuating rather than stationary background noises. In the present study, the factors determining the loudness of fluctuating noises were examined using psychoacoustical procedures. The results indicated that loudness of fluctuating noises was best represented by the same percentile loudness N15 or percentile level L15. This is the value that is reached or exceeded in 15% of the analysed measurement time. The percentile level L15 or the percentile loudness N15 may be used to measure the level of noises with identical spectra. However, subjective loudness is approximated only by the percentile loudness N15 if the stationary and the fluctuating noises are spectrally different.

Adult

Trisomy 13 and extended survival.

A 9-year-old boy with classical clinical features of trisomy 13 (Patau's syndrome), with confirmation on chromosome analysis of blood and skin, is reported in view of his relative longevity.

Abnormalities, Multiple

The role of danazol in the management of precocious puberty.

The management, investigation and treatment of 12 children with precocious puberty is described. Danazol, a synthetic derivative of ethisterone, has been used over a period of 3 1/2 years. Its clinical, endocrine and biochemical effects have been evaluated. Danazol ha a very useful clinical effect in controlling the development of secondary sexual features but does not modify the rapid linear growth and skeletal maturity seen in this condition.

17-Ketosteroids

Repeat lumbar puncture in the diagnosis of meningitis.

Meningitis may be difficult to diagnose. If it is suspected clinically and a first lumbar puncture is normal, a second cerebrospinal fluid (CSF) sample may be required within a few hours to confirm the diagnosis. A child is presented in whom CSF was normal 14 hours after the onset of illness, but who 14 hours later showed the characteristic changes of purulent meningitis. This case differs from those previously cited in the literature, in that the blood cultures taken at the time of the first lumbar puncture were also negative.

Humans

Hearing conservation.

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Hearing Loss, Noise-Induced

Surgical repair of atrial septal defect in a dog.

Atrial septal defect, a relatively rare canine congenital cardiovascular defect, caused syncope during excitement in a 5-year-old male Boxer dog. The defect was successfully repaired by open heart surgery.

Animals